Noorul Islam College of Dental Science

Inflammation is often associated with the development and progression of cancer. The cells responsible for cancer-associated inflammation are genetically stable and thus are not subjected to rapid emergence of drug resistance; therefore, the targeting of inflammation represents an attractive strategy both for cancer prevention and for cancer therapy. Tumor-extrinsic inflammation is caused by many factors, including bacterial and viral infections, autoimmune diseases, obesity, tobacco smoking, asbestos exposure, and excessive alcohol consumption, all of which increase cancer risk and stimulate malignant progression. In contrast, cancer-intrinsic or cancer-elicited inflammation can be triggered by cancer-initiating mutations and can contribute to malignant progression through the recruitment and activation of inflammatory cells. Both extrinsic and intrinsic inflammations can result in immunosuppression, thereby providing a preferred background for tumor development. The current review provides a link between inflammation and cancer development.

Oral health is not separate from general health, but maintaining oral health is definitely difficult and different in old age. Even though, few elderly have physical and/or mental situation that call for particular interest in the dental workplace, one should not presume that all elderly community shares these circumstances. In order to achieve health, it is necessary to know few aspects of old age. In due course of old age body tissues get harder, collection of waste products in body cells and loss of lubrication leads to impaired functions of various organs. The design and implementation of comprehensive preventive dentistry protocols for elders presents the dental profession with many challenges. Although a specific protocol must be tailored to meet the unique needs of the individual patient, there are certain factors common to elderly segment of the population that may influence these protocols.

AIMS AND OBJECTIVES: Dental implants have emerged as new treatment modality for the majority of patients and are expected to play a significant role in oral rehabilitation in the future. The present study was conducted to assess various factors affecting the survival rate of dental implants. MATERIALS AND METHODS: The present retrospective study was conducted in the Department of Prosthodontics. In this study, 5200 patients with dental implants which were placed during June 2008-April 2015 were included. Exclusion criteria were patients with hormonal imbalance, patients with chronic infectious disease, patients receiving immunosuppressive therapy, pregnant women, drug and alcohol addicts, and patients with severe periodontal diseases. Parameters such as name, age, gender, length of implant, diameter of implant, location of implant, and bone quality were recorded. Data were tabulated and statistically evaluated with IBM SPSS Statistics for Windows, Version 20.0., IBM Corp., Armonk, NY, USA. RESULTS: < 0.05). CONCLUSION: Age, length of implant, diameter of implant, bone quality, and region of implant are factors determining the survival rate of implants. We found that implant above 11.5 mm length, and with diameter <3.75 mm, placed in the mandibular posterior region, in Type III bone showed maximum failures.

Platelets can play a crucial role in periodontal regeneration as they are reservoirs of growth factors and cytokines which are the key factors for regeneration of the bone and maturation of the soft tissue. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous platelet concentrates prepared from patient’s own blood. Recent researches are being focused on the development of therapeutic alternatives which are easy to prepare, non-toxic or biocompatible to living tissues and economically cheap that might result in the local release of growth factors accelerating hard and soft tissue healing. PRF is a natural fibrin-based biomaterial prepared from an anticoagulant-free blood harvest without any artificial biochemical modification that allows obtaining fibrin membranes enriched with platelets and growth factors. Evidence from the literature suggests the potential role of PRF in periodontal regeneration and tissue engineering. The slow polymerization during centrifugation and fibrin-based structure makes PRF a better healing biomaterial than PRP and other fibrin adhesives. The main aim of this review article is to briefly describe the novel platelet concentrate PRF and its potential role in periodontal regeneration.

Despite the fact that a biological classification of congenital vascular tumors and malformations was first published in 1982 by Mulliken and Glowacki, significant confusion still prevails due to the indiscriminate and interchangeable use of the terms hemangioma and vascular malformation. Hemangiomas are true neoplasms of endothelial cells and should be differentiated from vascular malformations which are localized defects of vascular morphogenesis. On an analysis of various scientific articles and latest edition of medical text books an inappropriate use of various terms for vascular lesions was found, contributing further towards the confusion. The widely accepted International Society for the Study of Vascular Anomalies (ISSVA) classification differentiates lesions with proliferative endothelium from lesions with structural anomalies and has been very helpful in standardizing the terminologies. In addition to overcoming obstacles in communication when describing a vascular lesion, it is important that we adhere to the correct terminology, as the therapeutic guidelines, management and follow-up of these lesions differ.

BACKGROUND: Ethnomedicine is gaining admiration since years but still there is abundant medicinal flora which is unrevealed through research. The study was conducted to assess the in vitro antimicrobial potential and also determine the minimum inhibitory concentration (MIC) of Citrus sinensis peel extracts with a view of searching a novel extract as a remedy for dental caries pathogens. MATERIAL AND METHODS: Aqueous and ethanol (cold and hot) extracts prepared from peel of Citrus sinensis were screened for in vitro antimicrobial activity against Streptococcus mutans and Lactobacillus acidophilus, using agar well diffusion method. The lowest concentration of every extract considered as the minimal inhibitory concentration (MIC) values were determined for both test organisms. One way ANOVA with Post Hoc Bonferroni test was applied for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively. RESULTS: Dental caries pathogens were inhibited most by hot ethanolic extract of Citrus sinensispeel followed by cold ethanolic extract. Aqueous extracts were effective at very high concentrations. Minimum inhibitory concentration of hot and cold ethanolic extracts of Citrus sinensis peel ranged between 12-15 mg/ml against both the dental caries pathogens. CONCLUSIONS: Citrus sinensispeels extract was found to be effective against dental caries pathogens and contain compounds with therapeutic potential. Nevertheless, clinical trials on the effect of these plants are essential before advocating large-scale therapy. KEY WORDS: Agar well diffusion, antimicrobial activity, dental caries, Streptococcus mutans, Lactobacillus acidophilus.

INTRODUCTION: Dental caries is known to be one of the most widespread, chronic infections affecting all ages and populations worldwide. The plethora of oral microbial population paves way for various endogenous infections and plays a crucial role in polymicrobial interactions contributing to biofilm-mediated diseases like caries and periodontal diseases. METHODS: . The literature was analyzed thoroughly and critical review was performed. RESULTS: The risk of development of secondary caries and residual caries further results in treatment failure. Drug resistance developed by oral microbes and further side effects pose serious hurdles in the current therapeutic strategies. The hyperactivities of various MMPs and the resulting massive ECM degradation are the challenging part in the design of effective therapeutic approaches. Anticariogenic phytotherapy is well appreciated owing to lesser side effects and versatility of their action. But appreciable outcomes regarding the phytochemical bioavailability and bioretention are still challenging. Site-specific delivery of phytoagents at the infected site may enhance the efficiency of these drugs. Accordingly emerging phytodentistry can be promising for the management of secondary and residual caries. CONCLUSION: This article presents major cariogens and their mechanisms in initiating and aggravating dental caries. Effectiveness of phytotherapy and different mode of action of phytochemicals against cariogens are outlined. The article also raises major concerns and possibilities of phytochemical based therapeutics to be applied in the clinical arena of caries management.

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.

BACKGROUND: Multinucleated giant cells (MNCs) form an integral part of numerous bone and soft tissue tumors, tumor-like lesions and are often associated with granulomas of immunological and nonimmunological origin. The presence of various types of giant cells depends on the lesions in which they are present which are difficult to be diagnosed under routine histological techniques. Immunohistochemistry can be used for a better diagnosis and understanding of the origin of various giant cells using various markers of immune response like human leukocyte antigen-DR (HLA-DR) and those expressed on monocytes and macrophages like CD 68 and leukocyte common antigen (LCA). MATERIALS AND METHODS: The study group consisted of 10 cases of giant cell tumor (GCT) of long bones, tuberculous granuloma, and giant cell granuloma to evaluate and analyze the expression pattern of LCA, CD 68, and HLA-DR in various giant cell lesions. RESULTS: Strong expression of CD 68 was observed in 80% of the lesions, strong and moderate expression of CD 45 observed in 70% of the lesions among and within the groups. In contrast, HLA-DR demonstrated negative expression in 80% of cases except for tuberculous granuloma where all the 10 cases showed moderate to strong immunoreactivity. CONCLUSION: CD 68 and CD 45 expression was found in central giant cell granuloma, peripheral giant cell granuloma and GCT, suggesting the origin from mononuclear phagocyte system and considering their clinical behavior of osteoclast type. High expressivity of HLA-DR in tuberculous granulomas which is an essential factor for presentation of the microbial antigen to CD 4 helper cells thus reassuring the fact that they are up-regulated in response to infection.

The majority of opportunistic oral mucosal fungal infections are due to Candida albicans and Aspergillus fumigatus species. Mucor and Cryptococcus also have a major role in causing oral infections, whereas Geotrichum, Fusarium, Rhodotorula, Saccharomyces and Penicillium marneffei are uncommon pathogens in the oral cavity. The broad spectrum of clinical presentation includes pseudo-membranes, abscesses, ulcers, pustules and extensive tissue necrosis involving bone. This review discusses various uncommon opportunistic fungal infections affecting the oral cavity including their morphology, clinical features and diagnostic methods.

BACKGROUND: Recent research indicated that periodontal infection may worsen systemic diseases, including pulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract. METHODS: A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age-, sex-, and race-matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ(2) and Student t tests were used for statistical analyses. RESULTS: The comparison of study-population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high-income patients. Smokers had significantly higher CALs compared to non-smokers in the control group. CONCLUSION: The findings of the present analysis support an association between respiratory and periodontal disease.

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the "gold-standard" over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel-titanium (Ni-Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel-titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

BACKGROUND: The role of interleukin (IL)-1β in periodontal disease pathogenesis is well researched. This study aimed to assess and compare the salivary IL-1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and periodontally healthy controls. Further, relationships between IL-1β levels and various clinical parameters were explored. METHODS: Twenty-eight patients with moderate-to-severe generalized chronic periodontitis and 24 age-, race-, and ethnicity-matched controls participated in this study. Saliva samples were obtained from all patients. The clinical parameters recorded were clinical attachment loss (AL), probing depth, bleeding on probing, periodontal index, and gingival index. Clinical evaluation and sample collection were repeated 1 month after periodontal phase I therapy in patients with periodontitis. IL-1β levels were assessed using enzyme-linked immunosorbent assay. RESULTS: Mean IL-1β levels in patients with periodontitis at baseline (1,312.75 pg/mL) were significantly higher (P <0.0001; eight-fold) than in controls (161.51 pg/mL). Although treatment in patients with periodontitis resulted in significant reduction in IL-1β levels (mean: 674.34 pg/mL; P = 0.001), they remained significantly higher (P <0.0001; four-fold) than control levels. There were significant correlations between IL-1β levels and all clinical parameters (P <0.01) except percentage sites with clinical AL >2 mm (P >0.05). CONCLUSIONS: The data indicate that IL-1β levels are raised in the saliva of patients with chronic periodontitis, which are reduced after phase I therapy, suggesting a close association between salivary IL-1β and periodontitis. Additional longitudinal studies are needed to validate salivary IL-1β as a marker for periodontal disease.

Gingival biotype has a significant impact on the outcome of restorative and regenerative therapy. The disparity in treatment outcome is possibly because of the difference in tissue response to trauma. Hence in clinical practice identification of the periodontal biotype is significant. Gingival thickness can be assessed by various invasive and non invasive methods. Thick and thin tissues often respond differently to inflammation and trauma. Periodontal surgical technique can improve the tissue quality and treatment outcome. This review paper highlights the general aspects of gingival biotype, methods to assess gingival thickness, response to treatment, techniques to improve tissue quality and its clinical significance.

Gorlin-Goltz syndrome is an autosomal dominant inherited disorder characterized by the presence of multiple odontogenic keratocysts along with various cutaneous, dental, osseous, ophthalmic, neurological, and sex organ abnormalities. Early diagnosis is essential as it may progress to aggressive basal cell carcinomas and neoplasias. Gorlin-Goltz syndrome has rarely been reported from India. We report here one such patient, diagnosed at a rural hospital.

INTRODUCTION: Periodontal disease is characterised by chronic infection and inflammation in periodontal tissues leading to destruction of alveolar bone with subsequent tooth loss. Periodontal infections are the result of an interaction between tooth associated microbial biofilms and the host defences. Periodontal pathogens can affect local and systemic immune and inflammatory responses. AIM: The aim of the present study was to evaluate serum C-Reactive Protein (CRP), plasma fibrinogen and peripheral blood levels in healthy subjects, chronic and aggressive periodontitis patients. MATERIALS AND METHODS: A total of 55 subjects, 27 males and 28 females were selected for the study. Blood samples were taken from healthy controls (n=20) and patients with chronic periodontitis (n=20) and aggressive periodontitis (n=15). The periodontal status of each patient was assessed by recording Oral Hygiene Index-Simplified (OHI-S), Bleeding Index (BI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). The levels of serum CRP were measured using high sensitivity Enzyme Linked Immunosorbent Assay (ELISA) and levels of plasma fibrinogen were measured using Quantitative Immunoturbidimetric assay. Data description was done in the form of mean and standard deviation and analysis of data was done using one way ANOVA (Analysis of Variance) and Students t-test to test the statistical significance between groups. RESULTS: The levels of serum CRP and plasma fibrinogen was increased in patients with chronic and aggressive periodontitis when compared to healthy controls (p<0.001). A positive correlation was found to exist between levels of clinical parameters like OHI-S, BI, PPD and CAL when compared with CRP and fibrinogen as well as with the study groups. CONCLUSION: The finding of the present study suggests the role of serum as a diagnostic marker in inflammatory conditions and indicates that levels of CRP and fibrinogen may serve as important biomarkers for evaluating the association between periodontitis and cardiovascular diseases.

BACKGROUND: Pain caused by hypersensitivity is very common and a variety of agents have been tried and tested to put an end to this ailment, but with limited or short-term success. The search for an agent that would predictably and permanently occlude the tubules and blend with them has prompted the use of durapatite/hydroxyapatite (HAP), which is the principal inorganic constituent of the tooth. METHODS: A total of 486 hypersensitive teeth in 45 patients with hypersensitive symptoms confirmed by visual analog scale and verbal rating scale were divided into four groups. Two were treated with HAP in two forms (dry sol gel and liquid precipitate form), and the other two groups included a positive control group (distilled water) and a negative control group (no treatment). The responses were evaluated at 0 and 1 days, and 1, 2, 4, and 8 weeks, for all groups. Ten freshly extracted teeth were prepared and treated as mentioned previously and subjected to scanning electron microscopy to assess the tubule occlusion. RESULTS: HAP-treated teeth showed statistically significant reduction in hypersensitive symptoms (P <0.001) compared to the other groups at the end of 1 day and 1, 2, and 4 weeks, but at the end of 8 weeks all four groups showed no statistical differences (P <0.5). The scanning electron microscopic study showed completely obliterated dentinal tubules in the HAP-treated specimens, whereas the other groups showed predominantly open or partially occluded tubules. CONCLUSIONS: HAP shows definite potential as an effective and permanent desensitizer when used as an in-office procedure. However, further long-term studies and comparative clinical trials with other popular desensitizing methods need to be carried out to prove its superiority.

Epithelial-mesenchymal transition (EMT) is an important event in embryonic development, fibrosis and cancer invasion. During cancer progression, the activation of EMT permits cancer cells to acquire migratory, invasive and stem-like properties. Despite recent advances in treatment, there is no improvement in the 5-year overall survival rate of oral squamous cell carcinoma (OSCC). Local recurrence and lymph node metastasis are considered to be mainly responsible for the low survival rate in OSCC. EMT plays a major role in local recurrence and lymph node metastasis of oral cancer. This review article addresses the clinical implications of EMT in OSCC and explains the molecular mechanisms of EMT, highlighting the cadherin switching and signaling pathways involved.

AIM: The treatment of white lesions should aim at arresting the lesion progression of carious lesions and improving the esthetics by diminishing the opacity of the developmental disturbances of a tooth. The objective of this review was to present the scientific basis, the principles of resin infiltration and to discuss its inherent clinical applications. DATA SOURCES: Data were identified by PubMed searches. Papers published in English between 2010 and 2015 were selected and most up-to-date or relevant references were chosen. CONCLUSION: The resin infiltration technique, while promising, needed more clinical evidence for conclusive findings. However, based on available laboratory and clinical studies, it seems convincing that resin infiltration of enamel lesions should aim at arresting the progression of white spot lesions. Combining this microinvasive approach with a substantial caries remineralization program may provide therapeutic benefits and significantly reduce both long term restorative needs and costs, thus complementing the concept of minimum intervention dentistry. HOW TO CITE THIS ARTICLE: Is Resin Infiltration a Micro invasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent 2019;12(1):53-58.

BACKGROUND: Ever-changing perception of beauty from childhood to old age is changing with the revolution in cosmeceuticals science. Esthetics is an individual's perception since time immemorial. Standards of beauty have changed through centuries with increased awareness about esthetics. The face remains main source of information for identification and discrimination. It constitutes a structural ground for many nonverbal messages including the emotional state of a person, so the proverb "Face is an index of mind" holds good. The wrinkles and laxity are considered to be one of the factors for aging. Hence, escalating demand for cosmetic treatment to reduce facial wrinkles and laxity has stimulated us to search for published literature for nonsurgical techniques for enhancement of facial beauty. The review analyzed the published data to provide narrative basic review in a concise way to the beginners, clinicians, and students. MATERIALS AND METHODS: We have adopted search criteria using keywords: Botox, Botulinum toxin, incobotulinumtoxinA, esthetics, face, uses of Botox, with various Boolean operators and or in title, and abstract using PubMed search engine. The database search limited to PubMed only from January 2013 to June 2018. RESULTS: Various search results have been appended as annexures at the end of the article for further reference for the readers. Finally, 17 references were selected to write narrative review to meet our objectives. CONCLUSION: The advancing front in the use of toxins is an emerging science for the beautification of a face. Botox exploded in to market because of efficacy, tolerability, and minimally invasive nature. The present review gives brief about the history of Botulinum toxin, types, mechanism of action, clinical indications, preparations, storage, and technique for various uses with a brief note on patient selection, contraindications, and complications.